- University of Rochester (Rochester, NY)
- …patients COBRA entitlement and assist with paperwork if necessary. **Compliance** + Review Medicare for MSP questions and validations. Investigates and corrects ... to authorizations, coordination of benefits, baby not on policy, Cobra entitlement, Medicare Lifetime Reserve days, and Medicare Advantage issues. This role… more
- US Tech Solutions (May, OK)
- …or denied prior authorizations. **Responsibilities:** + Ensure accuracy of case setup and clinical review of Medicare appeals cases. + Review internal notes ... for clinical information to decision cases + Utilize work instructions and Medicare guidelines for accurate case processing. + Comply with CMS mandated timelines… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...reports:- - - 2nd insurance level report - - Medicare and Medicaid credit balance report - - Over… more
- Masonicare (Wallingford, CT)
- …family and interdisciplinary care team. + Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings. + ... relates to facility care practices + Manages the patient's Medicare benefit by communication of skilled needs to the...Assists with Medicare denial claims/reviews when need is identified by billing… more
- Centene Corporation (Dover, DE)
- …cost containment, and quality improvement activities within the LTSS and Medicare -Medicaid Duals populations. + Review complex, controversial, or experimental ... initiatives for both the Long-Term Services and Supports (LTSS) and Medicare -Medicaid Duals populations. Additionally, the Medical Director will collaborate with… more
- University of Rochester (Rochester, NY)
- …audits, and third-party payer audits. - Coordinate responses and resolution to Medicaid and Medicare credit balances- - - Review all accounts on the Medicaid and ... resolution and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of...the account to a self-pay financial class after a review of previous efforts has not resulted in revenue… more
- Alameda Health System (Alameda, CA)
- …is documented and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate ... Assigns, assists, and instructs all staff in the RAI Process, Case-Mix, PPS Medicare , Medicaid, and the clinical computer system in relation to these processes. 8.… more
- New York State Civil Service (Buffalo, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a license ... HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Greater Binghamton Health Center, P26033...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- New York State Civil Service (Bronx, NY)
- … review experience in a health care facility regulated by Centers for Medicare and Medicaid Services Utilization Review Standards, or* Possession of a license ... HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center...on any of the Federal and/or State Medicaid and Medicare exclusion lists (or excluded from any other Federal… more
- Avera (Fargo, ND)
- …Avera hospitals, clinics, and nursing. + Manage and maintain workflows for filing and review of Medicare , Medicaid and Tricare cost reports for the assigned ... eligible for relocation assistance. Seeking a candidate with 5+ years of Medicare Cost Reporting experience. Avera offers ccompetitive salary and benefits! **You… more